Cutting Through The Crap

Monday, February 9, 2009

A Play With No Acts

The scene: In scrub clothes, a surgeon is addressing elected representatives. Stage left, curtained off and visible only to the audience, a patient lies gravely ill, attended by two nurses. The surgeon clears his throat a couple of times, taps on the microphone. The assemblage continues to talk amongst themselves, or move aimlessly in and out of the room. Some are sleeping, others flipping through press releases.

Surgeon: "Ladies and gentlemen, please. I have urgent business. [Taps again, clears throat.] Pursuant to articles eleven through nine hundred thirty one, I stand before you again to profess the immediate need of, and to obtain permission for operating on Patient X, who, we now know, has free perforation of a diverticulum of the sigmoid colon, with generalized peritonitis. I cannot overemphasize the importance of immediate intervention. The patient could die, and will surely do so if we don't proceed. As required, I seek your permission, and, with respect, I need it now."

A Senator, leaning to a colleague: "What did he just say? Perferdiversigmo? What the fuck is that? It's free?"

The colleague: "Damned if I know. I'm hungry. Are you hungry? I'm really hungry. Is the dining room still open? Are you hungry? I'm starving."

Surgeon: "If you will all have a look at this Xray you'll see what we call "free air" ...."

Senator: "Well, that's just silly. If you look at my chart, you'll see the amount of air available in the last eight years, and you'll notice it's no less than now. I've always been for air. Always."

Surgeon: "Sir, I think that's a little off point. What I'm trying to say is that stool is leaking and infection is spreading throughout..."

Senator: "Who do you think you are, doctor? First of all, shame on you for saying "stool." And "leaking." You nasty man. And all that urgency stuff. It's scare tactics, just scare tactics."

Another Senator: "From what I hear, when you operate it just makes things worse. My naturopath says high fiber."

Stage left, more people enter and look worriedly at the patient.

Another: "Chiropractors are really great. Got one works on my grand kids, none of them has diculums."

Another: "Homey-pathy. That's the stuff. I use a homey-path. Water has memory. Did you know that? Memory. More'n I can say for my staff. Har har."

Still another: "When I had that tickleitis thing they gave me antibiotics, and it worked just fine."

Surgeon: "We're giving antibiotics, maximum doses, and sometimes that's enough. But this isn't that kind of case. We need to operate, because there's a hole in his bowel. If we don't address that, he'll die. I've seen many, many.... Here's the data. His white count..."

Senator: "That's just scare tactics. I thought you were against scare tactics. That's just scare tactics. Aren't you against that? Scare tactics, I mean."

Surgeon: "It's not scare tactics when it's true, Senator. Go look at him. The man is sick as hell. Anyone can see it."

Stage left, someone grabs a phone off the wall and starts gesturing excitedly.

Senator: "Well, you listen to me, sonny boy. I don't need to look at him. Don't go telling me what I should be looking at. Shameful. I may not be a doctor, but I watch "House." Good show, by the way. They try all sorts of stuff. Never works the first time, take 'em off this, give 'em that. Those doctors do everything, surgery, xray thingies, bust into homes, don't ask permission. That House guy. Real American. Rush Limbaugh kind of American, way he talks, pills and everything. Har. Sorry, Rush."

Surgeon: "Excuse me, Senator. That show bears no relation to medical reality. We have..."

Senator: "Dockie, it looks real enough to me. Plenty real. Popular show where I come from. More damn popular than you are, I'm here to say. By the way, what about alternatives? Have you tried Head-On? I've seen commercials for it, and it looks damn good. Easy. I move that Head-On be tried first."

Someone: "Second."

Stage left, an emergency cart is wheeled into the area.

Clerk: "It has been moved and seconded..."

The vote proceeds, and the motion fails with 41 yes votes, all from the same side of the aisle. Stage left, a person enters with more Xrays and papers.

Surgeon: "People, listen to me. This is a very serious situation. I've just been told the patient has a positive blood culture and is going into septic shock. There's only one..."

Senator: "Oh, well, listen to the hoidy-toidy doctor, going all med school on us. Positive. Culture. Shock. Elitist, anyone? Doctor, I may not have gone to medical school but I know about culture, and I WILL be heard."

Another senator: "What, exactly, do you propose to do in this operation?"

Surgeon: "I'm glad you asked, sir, because that's the real issue. We'll be putting him to sleep, opening his abdomen, washing out his belly with liters [A senator snorts: liters? What's wrong with quarts? This is America!] of fluids, removing part of the colon. Almost certainly we'll need to give him a temporary colostomy...."

Senator: "Whoa, whoa, whoa. Putting him to sleep? What's wrong with hypnosis? Or that acupuncture?"

Surgeon: "Senator, I really think...."

Senator: "Wait just a minute, sonny. Acupuncture works. I saw a Youtube... Fifty needles, or I'm saying no to the operation."

Surgeon: "Well, after he's asleep I suppose we could..."

Senator: "And I don't like the idea of a colostomy. No colostomy. I knew a guy...."

Surgeon: "Senator, it's pretty dangerous not to do one if the patient is in shock...."

Senator: "Don't like 'em, wouldn't have one. Not doing one today. They stink. Ronald Reagan never had one. No colostomy."

Stage left, a medical student faints.

Another Senator rises: "Ladies and gentlemen, I think we need to listen to the doctor. He's an expert. None of us has gone to medical school, none of us knows how to operate. I've talked to the surgeon, and he seems to know what he's doing. Other surgeons agree with him. The patient trusts him, and wants to go ahead. So does his wife, and some kid that was in there. Let's just...."

Another: "Oh no you don't. I got me elected here, my people don't much like all this surgery stuff. Lots of prayin' folks in my district, prayin' and singin' and asking the Lord for help. That's what we... Besides, the doc already did an operation today. People get all perforated, what we need is cutting back on surgery. Pretty soon they'll be operating on everyone. Telling us all we have to have one. Communists."

Surgeon: "If I may, Senators, this really is critical. It's real. We won't have a do-over. My patient will die..."

Another Senator: "Sorry, mister fancy doctor and your fifty nine senators, you aren't steamrolling us. This isn't bipartisan what you're doing. Not bipartisan. We get our say, you said we would. You say the guy is sick, gonna die. Well, maybe yes and maybe no. But just because you're a doctor[making air-quotes], with all that knowledge[double air-quotes]... We got us forty one votes over here, and until we get forty one percent of the operation, you're getting zilch. That's the way it works. We get our votes, textbooks or not. "

Surgeon: "But this patient is one hundred percent sick. You can't divvy up the cure. Only some things will work. If I may, sir, your ideas have been tried. They didn't work. Not enough saline. Wrong antibiotics, wrong operation. It's all been tried. There are papers..."

Senator: "Doctor, doctor, doctor. If God had wanted experts making decisions, he wouldn't have invented Congress. And he sure as hell wouldn't have invented filibusters. But here we are, you knife-happy know-it-all. Let's have another vote."

Slow fade to black....

The curtain rises. We see the patient surrounded by doctors and nurses, students, pharmacists. A woman weeping. Tilted head down, the gurney is in the shock position. Several IVs are running wide open. One doctor is holding defibrillator paddles. The surgeon enters and speaks:

Surgeon: "Okay, well, we just got permission to proceed. We can make six tenths of an incision, wash him out, but with no more than two quarts of saline..."

Assistant: "Quarts?"

Surgeon: "Don't ask. And if we resect, we have to anastomose. But we can do a loop colostomy, just not over a rod."

Assistant: "But isn't that..."

Surgeon: "I tried. It's the best I could get. And stop all the other antibiotics, hang a million units of penicillin. Only penicillin."

Your problem here, Sid, is that you assume the Senators are merely stupid or deluded. There's a more sinister interpretation, though: they might be at best simply indifferent to the patient's health or active desire the patient's death.

In the real world we have to seriously consider the possibility that the Republicans are acting rationally: That they are indifferent or actively hostile to our metric of the health of the economy.

A depression very quickly concentrates wealth to a faction of the bourgeoisie. The Republican party has been acting explicitly and openly for 30-40 years to concentrate wealth in certain factions of the bourgeoisie. Therefore, it's not at all a stretch to believe that the Republicans see the depression as an opportunity rather than a problem, just as they saw 9/11 as an opportunity.

"Bourgeoisie is a classification used in analyzing human societies to describe a social class of people. The bourgeoisie are members of the middle or merchant class, whose status or power comes from employment, education, and wealth. It is the class owning the means for producing wealth.[1] They are distinguished from those whose power comes from being born into an aristocratic family."

The middle class is the locus of the Republican party. We have employment, education, and medium wealth. That would be in contrast to the Dems, the aristocratic party, whose attraction to themselves comes from going to aristocratic schools (like Obama and Harvard, remember the excitement there?) How about Caroline, whose only resume was her family?

I believe it was Rahmbo who described the recession as an opportunity not to be wasted. I guess he's your real villain.

Thanks for understanding and making it clear to everyone. Republicans are acting rationally and opposing this ridiculous bill.

Oh, and thanks for the thoughtful opinion that Republicans want to kill people. We only love the unborn, I suppose.

Bill, Bill, Bill: take a breath. Or is that sarcasm? Where did the Bushes go to school again? Condi? To what party do most of the Wall Street biggies belong? To what party do the poorest belong?

I'm not sure Republicans WANT to kill people, exactly: it's just that the policies they love (wars, environmental ignorance, that sort of thing) happen to kill people. Collateral damage, you might say.

Finally, as to who's being smart opposing the bill. If you can where it takes you, you might follow this linkand see what many economists are saying.

Snark and hyperbole aside, it's hard to disagree that these are unique times: half a million jobs lost last month; the Fed has shot its interest rate wad; things are still getting worse. People are burrowing, making it a vicious cycle. And whereas I'm probably even less able to predict the future than you, I'm persuaded that absent a stimulus package, things will get much worse. Nor has there ever been such geopolitical/economic interrelationships. Arguing for doing nothing, or that tax cuts, once again, will solve all our needs, seems to fly in the face of the obvious. To me, anyway.

Do we need a stimulus? maybe. But the question right now is, is this bill the proper thing? Most of the money isn't spent in 2009. Most of it isn't spent on infrastructure. I think most of the money won't stimulate. I think we need a better bill.

Let's say a trillion $ should be spent. Who should spend it? Gubmint? Tell people they won't pay taxes this year and watch them blow through that money in a couple of months. New cars, home improvements, vacations, college tuition. There's some immediate stimulus.

Disagree? You probably do. But you don't have to say I want to kill people.

"Where did the Bushes go to school again? Condi? To what party do most of the Wall Street biggies belong? To what party do the poorest belong?"

I remember reading, perhaps on this very blog, about how Sarah Palin was deficient because she didn't go to an Ivy League school. Not because of her history, her work as gov, but because of her college.

Wall St biggies? I haven't seen any hard evidence--just anecdotal. Do you have some?

Poor people? Then who are all these millionaires in the cabinet now?

How about: which party pays its taxes?

Yes, more sarcasm.

I do have a serious question: Obama would like more income in the country. And he wants to rid us of our addiction to foreign oil.

Why not drill here? Use the shale oil in Nebraska? There's plenty of money there.

Bill, I disagree based on the data I see, which says that for each dollar "spent" on tax cuts the return is about a dollar, whereas for spending programs, it's about $1.59, and for assistance such as food stamps (which the "moderates" have cut from the bill (no relation)), it's about $1.79.

I haven't done the studies. But those numbers, or ones very similar, are seen time and again. The fact is, despite the R's claims, the D's have added and subtracted lots to please the R's, including, as you've said, too much in tax cuts and not enough in stimulus spending. The D's, in other words, have come toward the middle in the name, I suppose, of bipartisanship. But the R's have been intransigent, claiming lack of cooperation when it's in fact they that have made no moves toward the middle.

Of that, there's no doubt.

And when TBB was making his comment, it was following the analogy set up in my "play." Hardly literal, nor even ad hominem, when no hominids were mentioned.

Ah, the Cato institute, bastion of right wing thinking. The list is long, all right. The arguments in the heading say it all: tax cuts, tax cuts, tax cuts. Been there, done that: Reagan, Bush. Epic fail, as they say.

No kidding. We're here because of the policies espoused by the Cato institute. They want more of it.

Of course there are people who disagree. There were, after all, twenty-some percent of people who continued to idolize Bush. A list, per se, isn't persuasive. It's the arguments they make.

Bill, you didn't hear that Palin comment from me. She is indeed grandly unqualified, and poorly informed. Divisive, hateful, dishonest. But I never argued it had anything to do with her schooling.

There are lots of reasons to look to non-carbon-based energy. Surely I don't have to repeat them. A couple: finite supply, global warming, pollution. In my view, it may well be that local drilling will be necessary as a bridge to the future. But we're much better off eliminating fossil fuel (maybe natural gas is okay). If and when better disposal methods are found, I'm all for nuclear, by the way. And, of course, wind, solar, geo, hydro, and cow farts.

My post is not an ad hominem. it's not an automatic fallacy to infer a sinister motive from the evidence. An ad hominem fallacy is to infer the falseness of a position from the negative personal characteristics of its proponent. I'm going the other direction: I'm inferring the negative personal characteristics (sinister motives) of a group of people from the positions they advocate and the tactics they use to promote it.

It would be an ad hominem fallacy to say, "Republicans are evil; they oppose the stimulus bill; therefore the stimulus bill is good.

It's not an ad hominem fallacy (although it still might be mistaken) to say, "The stimulus bill is good; the Republicans oppose the stimulus bill; the Republicans are therefore evil."

I'm a communist; I use bourgeoisie in the communist sense: the economic class defined by ownership of capital.

A depression is good for some of the owners of capital, the Republicans are promoting a depression, therefore the Republicans are acting in the interests of some owners of capital.

Bravo! I was thinking of this post tonight during Obama's press conference when he mentioned the need to cure "ideological blockage". I'm sure the person on the treadmill next to mine wondered why I thought that was so funny!

For The Sake of My Sanity

Some will know me from my other blog, "Surgeonsblog." Of late I've given over to frothing at the mouth as the world descends into stupidity, and our politics and our citizens seem, in numbers enough to be meaningful, unable to see it. So for now I'm leaving surgery writing behind, if for no other reason than to defuse and diffuse my unrelenting sense of doom, and with no expectation of making a difference. These are things that, to me, are obvious. Except that, apparently, they aren't.

RWS™

RWS™: For those who drop by here in the middle, and wonder what it means: it's my shorthand for Right Wing Screamers, which includes such a long list it's tiresome to type it. (I distinguish these blowhards from thoughtful conservatives, of whom I sort of take it on faith that there must still be some.) You know who I mean: Palin, Beck, O'Reilly, Limbaugh, Hannity, Coulter, Breitbart (RIP), Malkin, Savage, Levin, Ingraham, Doocey (more of a drooler than a screamer), Hewitt, Goldberg, Gingrich, Kristol, Scarborough (+/-), Bachmann, Inhofe, Bond, Broun, Boehner, Kelley, Santorum, Cain. To name but a few. Behold them in their unrepentant disregard for reality: the RWS™

My Better Self

Have A Look At My Book

ReadWave

About Me

I'm a mostly retired general surgeon. With my surgical blog, my intention is to inform, entertain, and possibly educate the reader about surgery, and about the life and loves of a surgeon: this one, anyway. Don't know what I'm thinking, doing a political blog, too.
In an amazing coincidence, I've also written a book, "Cutting Remarks; Insights and Recollections of a Surgeon." It's about my surgical training in San Francisco in the 1970s, aimed at the lay reader with the goal of entertaining with good stories, informing with understandable details of surgical anatomy, procedures, and diseases. Knowing you, I bet you'd enjoy it. In fact, if you like Surgeonsblog, you'll absolutely love the book!